Abstract

Purpose Cryptococcal meningitis is a leading cause of mortality among HIV-infected individuals in sub-Saharan Africa but little is
known about its treatment and outcomes in decentralised HIV outpatient settings. We assessed adherence to treatment guidelines
and determined predictors of survival.

Results Medical records were located for 79% (71/90). Mortality was 38% (27/71) over a median follow-up period of 201 days (IQR:
10–705 days). Adherence to local guidelines for treatment of cryptococcal meningitis was 48% (34/71). Higher body mass index
was associated with improved survival (HR: 0.82, 95% CI (0.68 to 0.99)) even after controlling for factors such as age, CD4
cell count, receipt of highly active anti-retroviral therapy, and treatment with any anti-fungal therapy.

Conclusions Cryptococcal meningitis diagnosed in routine HIV outpatient settings is largely treated as an outpatient and adherence to
treatment guidelines is poor. Body mass index is a critical independent predictor of outcome. Additional research to determine
the most effective strategies to reduce premature mortality is urgently needed.